Abstract:
OBJECTIVE:Early assessment of neurologic recovery is often challenging in survivors of cardiac arrest. Further, little is known about when to assess neurologic status in comatose, postarrest patients receiving therapeutic hypothermia. We sought to evaluate timing of prognostication in cardiac arrest survivors who received therapeutic hypothermia. DESIGN:A retrospective chart review of consecutive postarrest patients receiving therapeutic hypothermia (protocol: 24-hr maintenance at target temperature followed by rewarming over 8 hrs). Data were abstracted from the medical chart, including documentation during the first 96 hrs post arrest of "poor" prognosis, diagnostic tests for neuroprognostication, consultations used for determination of prognosis, and outcome at discharge. SETTING:Two academic urban emergency departments. PATIENTS:A total of 55 consecutive patients who underwent therapeutic hypothermia were reviewed between September 2005 and April 2009. INTERVENTION:None. RESULTS:Of our cohort of comatose postarrest patients, 59% (29 of 49) were male, and the mean age was 56 ± 16 yrs. Chart documentation of "poor" or "grave" prognosis occurred "early": during induction, maintenance of cooling, rewarming, or within 15 hrs after normothermia in 57% (28 of 49) of cases. Of patients with early documentation of poor prognosis, 25% (seven of 28) had care withdrawn within 72 hrs post arrest, and 21% (six of 28) survived to discharge with favorable neurologic recovery. In the first 96 hrs post arrest: 88% (43 of 49) of patients received a head computed tomography, 90% (44 of 49) received electroencephalography, 2% (one of 49) received somatosensory evoked potential testing, and 71% (35 of 49) received neurology consultation. CONCLUSIONS:Documentation of "poor prognosis" occurred during therapeutic hypothermia in more than half of patients in our cohort. Premature documentation of poor prognosis may contribute to early decisions to withdraw care. Future guidelines should address when to best prognosticate in postarrest patients receiving therapeutic hypothermia.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Perman SM,Kirkpatrick JN,Reitsma AM,Gaieski DF,Lau B,Smith TM,Leary M,Fuchs BD,Levine JM,Abella BS,Becker LB,Merchant RMdoi
10.1097/CCM.0b013e3182372f93subject
Has Abstractpub_date
2012-03-01 00:00:00pages
719-24issue
3eissn
0090-3493issn
1530-0293journal_volume
40pub_type
杂志文章abstract:OBJECTIVE:Effective therapies are needed to reverse the increased vascular permeability that characterizes acute inflammatory diseases such as acute lung injury. FTY720 is a pharmaceutical analog of the potent barrier-enhancing phospholipid, sphingosine 1-phosphate. Because both FTY720 and sphingosine 1-phosphate have ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000097
更新日期:2014-03-01 00:00:00
abstract:OBJECTIVE:Acute respiratory distress syndrome is an abrupt inflammatory illness that involves damage from reactive oxygen species. We examined the efficacy and safety of oxothiazolidine-4-carboxylic acid (OTZ), a free radical scavenger, in treating acute respiratory distress syndrome. DESIGN:Double-blind, placebo-cont...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/CCM.0B013E318164E7E4
更新日期:2008-03-01 00:00:00
abstract:OBJECTIVES:We aimed to implement our Smart Use of Antibiotics Program to ensure the proper use of antimicrobials, improve patient care and outcomes, and reduce the risks of adverse effects and antimicrobial resistance. DESIGN:We compared the time periods before (baseline) and after (intervention) the implementation of...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003463
更新日期:2019-01-01 00:00:00
abstract:OBJECTIVES:In this study, we hypothesized that coronavirus disease 2019 patients exhibit sublingual microcirculatory alterations caused by inflammation, coagulopathy, and hypoxemia. DESIGN:Multicenter case-controlled study. SETTING:Two ICUs in The Netherlands and one in Switzerland. PATIENTS:Thirty-four critically i...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004862
更新日期:2021-01-07 00:00:00
abstract:OBJECTIVE:Rapid fluid loading is standard treatment for hypovolemia. Because volume expansion does not always improve hemodynamic status, predictive parameters of fluid responsiveness are needed. Passive leg raising is a reversible maneuver that mimics rapid volume expansion. Passive leg raising-induced changes in stro...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181c8fe7a
更新日期:2010-03-01 00:00:00
abstract:OBJECTIVES:To examine whether niacin attenuates lung inflammation and improves survival during sepsis and to determine whether the beneficial effects of niacin are associated with downregulation of the nuclear factor (NF)-κB pathway. DESIGN:Prospective laboratory study. SETTING:University laboratory. SUBJECTS:Male S...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181feeae4
更新日期:2011-02-01 00:00:00
abstract:OBJECTIVES:To establish Department of Veterans Affairs' intensive care unit (ICU) costs from a database and to use this information to validate the Russell equation, the most commonly used method of calculating ICU costs. To compare and trend Department of Veterans Affairs' and nationwide (USA) ICU and healthcare costs...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:
更新日期:1994-12-01 00:00:00
abstract:OBJECTIVE:To study the rate of elimination of ethanol after a major burn trauma. DESIGN:Prospective, controlled study. SETTING:National burns unit in a Swedish university hospital. PATIENTS AND SUBJECTS:Eight consecutive patients suffering from 18%-72% total burned surface area and nine healthy male control subjects...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-199912000-00003
更新日期:1999-12-01 00:00:00
abstract:OBJECTIVE:Anecdotal reports suggest that propofol (Diprivan) may stimulate mucus hypersecretion in patients without pulmonary disease. The purpose of this study was to evaluate the effect of methohexital or propofol anesthesia on the physical and transport properties of airway mucus in spontaneously breathing dogs. DE...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200105000-00035
更新日期:2001-05-01 00:00:00
abstract:OBJECTIVES:To describe the unique perspective of pediatric intensivists caring for critically ill adults during the coronavirus disease 2019 pandemic. DESIGN:Observational study. SETTING:Academic medical center in New York City. PATIENTS:Coronavirus disease 2019 positive adults requiring admission to an ICU. INTERV...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004543
更新日期:2020-11-01 00:00:00
abstract:OBJECTIVE:To provide a conceptual and clinical review of the physiology of the venous system as it is relates to cardiac function in health and disease. DATA:An integration of venous and cardiac physiology under normal conditions, critical illness, and resuscitation. SUMMARY:The usual teaching of cardiac physiology f...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182772ab6
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND:Hypertonic saline is the recommended therapy to shrink swollen brain cells in patients with acute hyponatremia accompanied by seizures. OBJECTIVES:In the absence of hypertonic saline, hypertonic mannitol will shrink the cell volume. Because mannitol is excreted rapidly, our aim was to ensure that it would b...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200006000-00037
更新日期:2000-06-01 00:00:00
abstract:OBJECTIVES:Severe sepsis poses a major burden on the U.S. healthcare system. Previous epidemiologic studies have not differentiated community-acquired severe sepsis from healthcare-associated severe sepsis or hospital-acquired severe sepsis hospitalizations. We sought to compare and contrast community-acquired severe s...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001164
更新日期:2015-09-01 00:00:00
abstract:OBJECTIVE:Prognostic information is important to the family members of incapacitated, critically ill patients, yet little is known about what prognostic information physicians provide. Our objectives were to determine the types of prognostic information provided to families of critically ill patients when making major ...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/01.CCM.0000254723.28270.14
更新日期:2007-02-01 00:00:00
abstract:OBJECTIVES:Secretoneurin is associated with cardiomyocyte Ca handling and improves risk prediction in patients with acute myocardial dysfunction. Whether secretoneurin improves risk assessment on top of established cardiac biomarkers and European System for Cardiac Operative Risk Evaluation II in patients undergoing ca...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003670
更新日期:2019-05-01 00:00:00
abstract:OBJECTIVE:Our knowledge of the molecular mechanisms of sepsis has attained exponential growth. Yet, the pillars of its care remain antibiotics, fluid resuscitation, and physiologic support of failing organ systems. The inability to bring biologic breakthroughs to the bedside is not for lack of effort. Over 60 clinical ...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0000000000003271
更新日期:2018-09-01 00:00:00
abstract:OBJECTIVES:Hyponatremia occurs in up to 30% of patients with pneumonia and is associated with increased morbidity and mortality. The prevalence of hyponatremia associated with coronavirus disease 2019 and the impact on outcome is unknown. We aimed to identify the prevalence, predictors, and impact on outcome of mild, m...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000004605
更新日期:2020-12-01 00:00:00
abstract:BACKGROUND AND METHODS:The development of a multifactorial coagulopathy after massive transfusion is a well-recognized clinical problem that is almost always accompanied by hypothermia. The purpose of this study was to investigate the isolated effect of alterations of temperature on the integrity of the coagulation cas...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199210000-00007
更新日期:1992-10-01 00:00:00
abstract:OBJECTIVE:In 1991, the American College of Chest Physicians (ACCP) and the Society of Critical Care Medicine (SCCM) convened a "Consensus Conference," the goals of which were "to provide a conceptual and a practical framework to define the systemic inflammatory response to infection, which is a progressive injurious pr...
journal_title:Critical care medicine
pub_type: 共识发展会议,杂志文章,评审
doi:10.1097/01.CCM.0000050454.01978.3B
更新日期:2003-04-01 00:00:00
abstract:OBJECTIVES:Acinetobacter baumannii complex bacteremia has been identified increasingly in critical patients admitted in ICUs. Notably, A. baumannii complex bacteremia has a high mortality rate, yet the risk factors associated with mortality remain unclear and controversial. DESIGN:Retrospective study. SETTING:All adu...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000125
更新日期:2014-05-01 00:00:00
abstract:OBJECTIVE:Perfluorocarbon liquid ventilation has been shown to enhance pulmonary mechanics and gas exchange in the setting of respiratory failure. To optimize the total liquid ventilation process, we developed a volume-limited, time-cycled liquid ventilatory support, consisting of an electrically actuated, microprocess...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200005000-00038
更新日期:2000-05-01 00:00:00
abstract:OBJECTIVE:Anesthetic preconditioning appears to be a viable strategy to treat ischemic cerebral injury. Here we investigated 1) whether the protection conferred by sevoflurane preconditioning sustains in time; 2) whether sevoflurane preconditioning diminishes mitochondrial dysfunction following cerebral ischemia; and 3...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e318258fb90
更新日期:2012-09-01 00:00:00
abstract:OBJECTIVE:Sepsis is a frequent cause of admission, but incidence rates based on administrative data have previously produced large differences in estimates. The aim of the study was to estimate the incidence of community-acquired sepsis based on patients' symptoms and clinical findings at arrival to the hospital. DESI...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000611
更新日期:2015-01-01 00:00:00
abstract:OBJECTIVE:Within minutes of reperfusing ischemic cardiomyocytes, oxidant stress dramatically increases and is associated with postresuscitation injury. Because mitochondria produce deleterious oxidants and useful metabolic substrates, utilization of electron transport chain inhibitors against reperfusion injury, though...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000246014.19486.A1
更新日期:2006-12-01 00:00:00
abstract:OBJECTIVE:To define the relative needs of the staffs of rural, community hospitals for training in advanced cardiac life support (ACLS), identify weaknesses, and modify a standard ACLS course to meet these needs. DESIGN:Prospective assessment of knowledge and skills relating to the practice of ACLS. SETTING:Rural, co...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199405000-00006
更新日期:1994-05-01 00:00:00
abstract:OBJECTIVES:To explore the relationship between timing of continuous renal replacement therapy commencement and clinical outcomes in critically ill patients with acute kidney injury. The primary outcomes were all-cause mortality at 28 and 90 days. DESIGN:Nested observational cohort study using data from the Randomized ...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/CCM.0000000000000343
更新日期:2014-08-01 00:00:00
abstract:OBJECTIVE:End-of-life practices vary worldwide. The objective was to demonstrate that there is no clear-cut distinction between treatments administered to relieve pain and suffering and those intended to shorten the dying process. DESIGN:Secondary analysis of a prospective, observational study. SETTING:Thirty-seven i...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/01.CCM.0000295304.99946.58
更新日期:2008-01-01 00:00:00
abstract:OBJECTIVE:Cardiogenic shock remains an important therapeutic challenge, with high in-hospital mortality rates. Mechanical circulatory support may be beneficial in these patients. Since the efficacy of the intra-aortic balloon pump seems limited, new percutaneously placed mechanical left ventricular support devices, suc...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31821e89b5
更新日期:2011-09-01 00:00:00
abstract::Patient comfort is not assured by common practices for terminal extubation. Treatment guidelines suggest minimizing dosage of opioids and sedatives. Multiple lines of evidence indicate that clinicians are limited in their ability to recognize distress in such patients and tend to undermedicate patients in distress. Ye...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e318228235d
更新日期:2012-02-01 00:00:00
abstract:OBJECTIVE:To describe the symptom experiences of family members of patients at high risk for dying in the intensive care unit and to assess risk factors associated with higher symptom burden. DESIGN:Prospective, cross-sectional study. SETTING:Three intensive care units at a large academic medical center. PARTICIPANT...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e3181cf6d94
更新日期:2010-04-01 00:00:00